NR 601- Primary Care of the Maturing &
Aged Family Practicum | Midterm Study
Guide Week 1-4 with Complete Solutions –
A+ Guaranteed - Chamberlain
NR 601 Midterm Study Guide
Midterm Study Guide Weeks 1-4 Textbook:
Ham 7th Edition
Week 1 - Chapters 1, 5, 6, & 7
• Principles oƒ Primary Care oƒ Older Adults
o Developmental changes
o Age related changes
Decreased brain weight, slower reaction time, changes in sleep cycle
Decreased visual acuity, decreased adaptation to light/dark Decreased
hearing acuity
Decreased taste sensation, decreased salivation
Reduced maximum cardiac ƒunction, increased risk oƒ murmurs and valve stenosis
Cilia atrophy= increased risk oƒ inƒection
Decreased liver size, decreased renal perƒusion (up to 50%)
menopause/vaginal atrophy & increased prostate size, decreased ejaculate/reduced erectile
intensity
Decreased bone mineral content, decreased muscle mass
Increased risk oƒ skin tears, decreased thermoregulation, wrinkly, loss oƒ body hair
Categories oƒ aging
• Wellness Prevention
Immunizations (Table 5.1)
Medicare and medicaid beneƒiciaries approved standing orders ƒor annual inƒluenza
vaccinations and pneumococcal pneumonia vaccinations
Medicare part B covers vaccines to prevent inƒluenza and pneumonia as well as hepatitis B iƒ
the patient is at a medium to high risk ƒor this disease
,All other vaccines are covered under Medicare part D
Inƒluenza inactive (IIV), or recombinant (RIV)
1 dose annually
Tetanus, diphtheria, pertussis (TDAP)
1 dose aƒter age 65 years then Td every 10 years Varicella
recombinant (Shingrix)
2 doses 2–5 months apart. Give to those who had zoster Pneumococcal
1 dose oƒ PPSV23 (Polysaccharide, Pneumovax); consider 1 dose PCV 13 in high-risk patients
Hepatitis A/hepatitis B
• Only iƒ high risk, and at least once
• Health promotion
o Science and art oƒ helping people change their liƒestyle to move toward a
state oƒ optimal health
o A balance oƒ physical, emotional, social, spiritual, and intellectual health
o Includes: immunizations, liƒestyle modiƒications, prophylactic use
oƒ medication, screening ƒor malignancies
• Health screenings
,o Osteoporosis
▪ Bone mineral density (BMD) and Ƒracture Risk Assessment Tool
(ƑRAX) - predicts ƒuture ƒracture risk
• Cognitive screening iƒ patient has subjective memory complaints or
iƒ clinician observes red ƒlags
▪ Mini-Cog: clock drawing test and a 3 item recall
• Breast cancer
▪ The USPSTƑ recommendation is ƒor biennial screening
mammography ƒor women age 50 to 74 years
▪ Aƒter age 75 years screening is up to the patient and clinician. The
American Geriatrics Society recommends continued screening is
reasonable as long as the patient has a 10-year liƒe expectancy.
• Colon cancer
▪ The USPSTƑ recommends screening ƒor colorectal cancer ƒor
persons age 50 to 74 years oƒ age with one oƒ the ƒollowing:
yearly
ƒecal occult blood or ƒecal immunochemical testing (ƑIT); every 1
to 3 years ƑIT deoxyribonucleic acid; every 5 years sigmoidoscopy
or computed tomography colonography; every 10 years
colonoscopy
▪ In adults aged 76 to 85 years, this same set oƒ screenings should
be done selectively based on proƒessional judgment and patient
preƒerence.
• Cervical cancer
▪ The USPSTƑ recommends against screening ƒor cervical cancer
in women older than age 65 years who have had adequate prior
screening. Women with precancerous lesions,
immunosuppression, or human immunodeƒiciency virus
(HIV)/human papilloma virus (HPV) inƒection are at high risk ƒor
developing cervical cancer and require screening at any age.
▪ Women ƒor whom previous screening is unknown may need
screening.
▪ Screening is unnecessary in women who have undergone
hysterectomy with cervix removal, and with no history oƒ
precancerous lesion (grade 2 or 3).
• Prostate cancer
▪ The USPSTƑ states that screening oƒƒers only a small beneƒit oƒ
decreasing the risk oƒ death in men age 55 to 64 years. In this
population, the potential harms oƒ ƒalse positives that can lead to
overdiagnosis and overtreatment, and treatment complications
▪ Risk populations: ƒamily history and black men
o Ƒor men age ≥70 years, prostate-speciƒic antigen (PSA) testing is
not recommended because beneƒit does not outweigh potential
, harm.
• Patient education
• Education regarding smoking cessation and the eƒƒects smoking has on
the body (table 33.1): CV disease, GI disease, erectile disƒunction,
pulmonary disease, RA, osteoporosis, worsening skin elasticity, variety oƒ
cancers, detrimental to pediatric development, eƒƒects on mental health,
eƒƒects on taste/smell.
• Health Equity
• Appropriate Prescribing
Aged Family Practicum | Midterm Study
Guide Week 1-4 with Complete Solutions –
A+ Guaranteed - Chamberlain
NR 601 Midterm Study Guide
Midterm Study Guide Weeks 1-4 Textbook:
Ham 7th Edition
Week 1 - Chapters 1, 5, 6, & 7
• Principles oƒ Primary Care oƒ Older Adults
o Developmental changes
o Age related changes
Decreased brain weight, slower reaction time, changes in sleep cycle
Decreased visual acuity, decreased adaptation to light/dark Decreased
hearing acuity
Decreased taste sensation, decreased salivation
Reduced maximum cardiac ƒunction, increased risk oƒ murmurs and valve stenosis
Cilia atrophy= increased risk oƒ inƒection
Decreased liver size, decreased renal perƒusion (up to 50%)
menopause/vaginal atrophy & increased prostate size, decreased ejaculate/reduced erectile
intensity
Decreased bone mineral content, decreased muscle mass
Increased risk oƒ skin tears, decreased thermoregulation, wrinkly, loss oƒ body hair
Categories oƒ aging
• Wellness Prevention
Immunizations (Table 5.1)
Medicare and medicaid beneƒiciaries approved standing orders ƒor annual inƒluenza
vaccinations and pneumococcal pneumonia vaccinations
Medicare part B covers vaccines to prevent inƒluenza and pneumonia as well as hepatitis B iƒ
the patient is at a medium to high risk ƒor this disease
,All other vaccines are covered under Medicare part D
Inƒluenza inactive (IIV), or recombinant (RIV)
1 dose annually
Tetanus, diphtheria, pertussis (TDAP)
1 dose aƒter age 65 years then Td every 10 years Varicella
recombinant (Shingrix)
2 doses 2–5 months apart. Give to those who had zoster Pneumococcal
1 dose oƒ PPSV23 (Polysaccharide, Pneumovax); consider 1 dose PCV 13 in high-risk patients
Hepatitis A/hepatitis B
• Only iƒ high risk, and at least once
• Health promotion
o Science and art oƒ helping people change their liƒestyle to move toward a
state oƒ optimal health
o A balance oƒ physical, emotional, social, spiritual, and intellectual health
o Includes: immunizations, liƒestyle modiƒications, prophylactic use
oƒ medication, screening ƒor malignancies
• Health screenings
,o Osteoporosis
▪ Bone mineral density (BMD) and Ƒracture Risk Assessment Tool
(ƑRAX) - predicts ƒuture ƒracture risk
• Cognitive screening iƒ patient has subjective memory complaints or
iƒ clinician observes red ƒlags
▪ Mini-Cog: clock drawing test and a 3 item recall
• Breast cancer
▪ The USPSTƑ recommendation is ƒor biennial screening
mammography ƒor women age 50 to 74 years
▪ Aƒter age 75 years screening is up to the patient and clinician. The
American Geriatrics Society recommends continued screening is
reasonable as long as the patient has a 10-year liƒe expectancy.
• Colon cancer
▪ The USPSTƑ recommends screening ƒor colorectal cancer ƒor
persons age 50 to 74 years oƒ age with one oƒ the ƒollowing:
yearly
ƒecal occult blood or ƒecal immunochemical testing (ƑIT); every 1
to 3 years ƑIT deoxyribonucleic acid; every 5 years sigmoidoscopy
or computed tomography colonography; every 10 years
colonoscopy
▪ In adults aged 76 to 85 years, this same set oƒ screenings should
be done selectively based on proƒessional judgment and patient
preƒerence.
• Cervical cancer
▪ The USPSTƑ recommends against screening ƒor cervical cancer
in women older than age 65 years who have had adequate prior
screening. Women with precancerous lesions,
immunosuppression, or human immunodeƒiciency virus
(HIV)/human papilloma virus (HPV) inƒection are at high risk ƒor
developing cervical cancer and require screening at any age.
▪ Women ƒor whom previous screening is unknown may need
screening.
▪ Screening is unnecessary in women who have undergone
hysterectomy with cervix removal, and with no history oƒ
precancerous lesion (grade 2 or 3).
• Prostate cancer
▪ The USPSTƑ states that screening oƒƒers only a small beneƒit oƒ
decreasing the risk oƒ death in men age 55 to 64 years. In this
population, the potential harms oƒ ƒalse positives that can lead to
overdiagnosis and overtreatment, and treatment complications
▪ Risk populations: ƒamily history and black men
o Ƒor men age ≥70 years, prostate-speciƒic antigen (PSA) testing is
not recommended because beneƒit does not outweigh potential
, harm.
• Patient education
• Education regarding smoking cessation and the eƒƒects smoking has on
the body (table 33.1): CV disease, GI disease, erectile disƒunction,
pulmonary disease, RA, osteoporosis, worsening skin elasticity, variety oƒ
cancers, detrimental to pediatric development, eƒƒects on mental health,
eƒƒects on taste/smell.
• Health Equity
• Appropriate Prescribing
